## Facts

- Dr. Floyd T. Bryan, a vascular surgeon with clinical privileges at a Florida hospital, accumulated more than 50 complaints alleging abusive and disruptive conduct toward hospital personnel.
- In August 1987, hospital leadership warned Bryan that further incidents could trigger formal disciplinary proceedings.
- Complaints continued, and the hospital initiated a multi-step peer review and disciplinary process concerning Bryan’s professional conduct and its effect on hospital operations and patient care.
- The hospital gathered complaints, investigated, and convened committees to review the matter; Bryan received notice and a peer-review hearing at which he could present evidence and argument and where he admitted much of the alleged conduct.
- A peer-review panel recommended a two-year suspension, but subsequent internal review bodies increased the sanction to permanent revocation of Bryan’s staff privileges.
- Bryan sued the hospital and others, asserting multiple theories; a key claim alleged breach of contract based on violation of hospital bylaws.
- After an eleven-day jury trial, the jury found a bylaw/contract violation and awarded Bryan nearly $4.2 million in damages; the district court denied the hospital’s motion for judgment as a matter of law asserting immunity from damages.

## Issues

1. Whether the hospital’s revocation of privileges qualified as a protected “professional review action” under the Health Care Quality Improvement Act (HCQIA) and satisfied the statutory conditions for immunity from money damages.
2. Whether Florida’s peer-review immunity statute independently barred money damages absent intentional fraud or malice.
3. Whether, in light of statutory immunity, the district court erred by allowing the breach-of-contract damages claim to go to the jury and by entering judgment on the verdict.

## Decision

- The Eleventh Circuit held the revocation of Bryan’s privileges was a “professional review action” covered by HCQIA.
- The court held the hospital was immune from liability for money damages because the action met HCQIA’s requirements and Bryan failed to rebut the statutory presumption of compliance.
- The court also held Florida’s peer-review immunity statute barred damages because the record did not show intentional fraud or malice.
- The court reversed the damages judgment and directed entry of judgment as a matter of law for the hospital on Bryan’s monetary claims.

## Legal Principles

- HCQIA provides immunity from money damages for participants in a “professional review action” if the action is taken:
  - in the reasonable belief it furthers quality health care,
  - after a reasonable effort to obtain the facts,
  - after adequate notice and hearing procedures, and
  - in the reasonable belief the action is warranted by known facts.
- A professional review action is presumed to satisfy HCQIA’s standards; the disciplined physician bears the burden to rebut the presumption by a preponderance of the evidence.
- Quality-of-care concerns under HCQIA include disruptive or unprofessional conduct that may compromise patient care and hospital functioning, not only clinical incompetence.
- HCQIA immunity applies broadly to damages claims under state or federal law, including state-law contract theories based on alleged bylaw violations; it does not foreclose non-damages relief.
- Florida peer-review immunity bars money damages for peer-review participants absent intentional fraud or malice.

## Conclusion

The court held that a hospital’s peer-review revocation of staff privileges based on persistent disruptive conduct was protected by HCQIA and Florida peer-review immunity, requiring judgment for the hospital on the physician’s claims for money damages despite a jury finding of bylaw/contract violations.


Bryan v. James E. Holmes Reg'l Med. Ctr., 33 F.3d 1318 (11th Cir. 1994)